|
NAFCILLIN 1gm/54mL BAG (ANES)
|
Facility
|
OP
|
$120.97
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
25004162
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.29 |
| Max. Negotiated Rate |
$116.13 |
| Rate for Payer: Aetna Commercial |
$93.15
|
| Rate for Payer: Anthem Medicaid |
$41.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$94.36
|
| Rate for Payer: Cash Price |
$60.48
|
| Rate for Payer: Cigna Commercial |
$100.41
|
| Rate for Payer: First Health Commercial |
$114.92
|
| Rate for Payer: Humana Commercial |
$102.82
|
| Rate for Payer: Humana KY Medicaid |
$41.60
|
| Rate for Payer: Kentucky WC Medicaid |
$42.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$99.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$89.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$106.45
|
| Rate for Payer: Ohio Health Group HMO |
$90.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$83.47
|
| Rate for Payer: PHCS Commercial |
$116.13
|
| Rate for Payer: United Healthcare All Payer |
$106.45
|
|
|
NAFCILLIN (20mg) 2GM/8ML
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
25003246
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.70 |
| Max. Negotiated Rate |
$123.84 |
| Rate for Payer: Aetna Commercial |
$99.33
|
| Rate for Payer: Anthem Medicaid |
$44.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$100.62
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$107.07
|
| Rate for Payer: First Health Commercial |
$122.55
|
| Rate for Payer: Humana Commercial |
$109.65
|
| Rate for Payer: Humana KY Medicaid |
$44.36
|
| Rate for Payer: Kentucky WC Medicaid |
$44.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$105.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$45.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$113.52
|
| Rate for Payer: Ohio Health Group HMO |
$96.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$103.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.01
|
| Rate for Payer: PHCS Commercial |
$123.84
|
| Rate for Payer: United Healthcare All Payer |
$113.52
|
|
|
NAFCILLIN (20mg) 2GM/8ML
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
25003246
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.70 |
| Max. Negotiated Rate |
$123.84 |
| Rate for Payer: Aetna Commercial |
$99.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$100.62
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$107.07
|
| Rate for Payer: First Health Commercial |
$122.55
|
| Rate for Payer: Humana Commercial |
$109.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$105.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$113.52
|
| Rate for Payer: Ohio Health Group HMO |
$96.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$103.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.01
|
| Rate for Payer: PHCS Commercial |
$123.84
|
| Rate for Payer: United Healthcare All Payer |
$113.52
|
|
|
NAFCILLIN 2gm/58mL BAG (ANES)
|
Facility
|
OP
|
$131.97
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
25004163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.59 |
| Max. Negotiated Rate |
$126.69 |
| Rate for Payer: Aetna Commercial |
$101.62
|
| Rate for Payer: Anthem Medicaid |
$45.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$102.94
|
| Rate for Payer: Cash Price |
$65.98
|
| Rate for Payer: Cigna Commercial |
$109.54
|
| Rate for Payer: First Health Commercial |
$125.37
|
| Rate for Payer: Humana Commercial |
$112.17
|
| Rate for Payer: Humana KY Medicaid |
$45.38
|
| Rate for Payer: Kentucky WC Medicaid |
$45.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$108.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$97.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$46.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$116.13
|
| Rate for Payer: Ohio Health Group HMO |
$98.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$105.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$114.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$91.06
|
| Rate for Payer: PHCS Commercial |
$126.69
|
| Rate for Payer: United Healthcare All Payer |
$116.13
|
|
|
NAFCILLIN 2gm/58mL BAG (ANES)
|
Facility
|
IP
|
$131.97
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
25004163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.59 |
| Max. Negotiated Rate |
$126.69 |
| Rate for Payer: Aetna Commercial |
$101.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$102.94
|
| Rate for Payer: Cash Price |
$65.98
|
| Rate for Payer: Cigna Commercial |
$109.54
|
| Rate for Payer: First Health Commercial |
$125.37
|
| Rate for Payer: Humana Commercial |
$112.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$108.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$97.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$116.13
|
| Rate for Payer: Ohio Health Group HMO |
$98.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$105.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$114.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$91.06
|
| Rate for Payer: PHCS Commercial |
$126.69
|
| Rate for Payer: United Healthcare All Payer |
$116.13
|
|
|
NAIL BED REPAIR
|
Facility
|
IP
|
$768.00
|
|
|
Service Code
|
HCPCS 11760
|
| Hospital Charge Code |
45000040
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$230.40 |
| Max. Negotiated Rate |
$737.28 |
| Rate for Payer: Aetna Commercial |
$591.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$599.04
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cigna Commercial |
$637.44
|
| Rate for Payer: First Health Commercial |
$729.60
|
| Rate for Payer: Humana Commercial |
$652.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$629.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$566.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$230.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$675.84
|
| Rate for Payer: Ohio Health Group HMO |
$576.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$614.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$529.92
|
| Rate for Payer: PHCS Commercial |
$737.28
|
| Rate for Payer: United Healthcare All Payer |
$675.84
|
|
|
NAIL BED REPAIR
|
Facility
|
OP
|
$768.00
|
|
|
Service Code
|
HCPCS 11760
|
| Hospital Charge Code |
45000040
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$264.12 |
| Max. Negotiated Rate |
$791.84 |
| Rate for Payer: Aetna Commercial |
$591.36
|
| Rate for Payer: Anthem Medicaid |
$264.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$565.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$599.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$791.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$763.56
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cigna Commercial |
$637.44
|
| Rate for Payer: First Health Commercial |
$729.60
|
| Rate for Payer: Humana Commercial |
$652.80
|
| Rate for Payer: Humana KY Medicaid |
$264.12
|
| Rate for Payer: Humana Medicare Advantage |
$565.60
|
| Rate for Payer: Kentucky WC Medicaid |
$266.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$629.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$566.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$678.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$269.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$675.84
|
| Rate for Payer: Ohio Health Group HMO |
$576.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$614.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$529.92
|
| Rate for Payer: PHCS Commercial |
$737.28
|
| Rate for Payer: United Healthcare All Payer |
$675.84
|
|
|
NAIL DEBRIDEMENT 6 OR MORE
|
Professional
|
Both
|
$334.00
|
|
|
Service Code
|
HCPCS 11721
|
| Hospital Charge Code |
76100095
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$14.91 |
| Max. Negotiated Rate |
$200.40 |
| Rate for Payer: Aetna Commercial |
$44.73
|
| Rate for Payer: Ambetter Exchange |
$22.63
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$14.91
|
| Rate for Payer: Anthem Medicaid |
$30.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$22.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$22.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$27.16
|
| Rate for Payer: Cash Price |
$167.00
|
| Rate for Payer: Cash Price |
$167.00
|
| Rate for Payer: Cigna Commercial |
$58.83
|
| Rate for Payer: Healthspan PPO |
$50.74
|
| Rate for Payer: Humana Medicaid |
$30.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$32.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$22.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$31.31
|
| Rate for Payer: Molina Healthcare Passport |
$30.70
|
| Rate for Payer: Multiplan PHCS |
$200.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$29.42
|
| Rate for Payer: UHCCP Medicaid |
$15.66
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$31.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$22.63
|
|
|
NAIL DEBRIDEMENT 6 OR MORE
|
Facility
|
OP
|
$334.00
|
|
|
Service Code
|
HCPCS 11721
|
| Hospital Charge Code |
76100095
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.88 |
| Max. Negotiated Rate |
$320.64 |
| Rate for Payer: Aetna Commercial |
$257.18
|
| Rate for Payer: Anthem Medicaid |
$114.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$54.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$260.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$76.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.09
|
| Rate for Payer: Cash Price |
$167.00
|
| Rate for Payer: Cash Price |
$167.00
|
| Rate for Payer: Cigna Commercial |
$277.22
|
| Rate for Payer: First Health Commercial |
$317.30
|
| Rate for Payer: Humana Commercial |
$283.90
|
| Rate for Payer: Humana KY Medicaid |
$114.86
|
| Rate for Payer: Humana Medicare Advantage |
$54.88
|
| Rate for Payer: Kentucky WC Medicaid |
$116.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$273.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$246.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$117.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$293.92
|
| Rate for Payer: Ohio Health Group HMO |
$250.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$267.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$290.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$230.46
|
| Rate for Payer: PHCS Commercial |
$320.64
|
| Rate for Payer: United Healthcare All Payer |
$293.92
|
|
|
NAIL DEBRIDEMENT 6 OR MORE
|
Facility
|
IP
|
$334.00
|
|
|
Service Code
|
HCPCS 11721
|
| Hospital Charge Code |
76100095
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.20 |
| Max. Negotiated Rate |
$320.64 |
| Rate for Payer: Aetna Commercial |
$257.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$260.52
|
| Rate for Payer: Cash Price |
$167.00
|
| Rate for Payer: Cigna Commercial |
$277.22
|
| Rate for Payer: First Health Commercial |
$317.30
|
| Rate for Payer: Humana Commercial |
$283.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$273.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$246.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$293.92
|
| Rate for Payer: Ohio Health Group HMO |
$250.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$267.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$290.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$230.46
|
| Rate for Payer: PHCS Commercial |
$320.64
|
| Rate for Payer: United Healthcare All Payer |
$293.92
|
|
|
NAIL DEBRIDEMENT 6 OR MORE(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 11721
|
| Hospital Charge Code |
761P0095
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$14.91 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna Commercial |
$44.73
|
| Rate for Payer: Ambetter Exchange |
$22.63
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$14.91
|
| Rate for Payer: Anthem Medicaid |
$30.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$22.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$22.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$27.16
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$58.83
|
| Rate for Payer: Healthspan PPO |
$50.74
|
| Rate for Payer: Humana Medicaid |
$30.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$32.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$22.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$31.31
|
| Rate for Payer: Molina Healthcare Passport |
$30.70
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$29.42
|
| Rate for Payer: UHCCP Medicaid |
$15.66
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$31.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$22.63
|
|
|
NAIL DEBRIDEMENT 6 OR MORE(T
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
HCPCS 11721
|
| Hospital Charge Code |
761T0095
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.70 |
| Max. Negotiated Rate |
$200.64 |
| Rate for Payer: Aetna Commercial |
$160.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$163.02
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Cigna Commercial |
$173.47
|
| Rate for Payer: First Health Commercial |
$198.55
|
| Rate for Payer: Humana Commercial |
$177.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$171.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$154.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$62.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$183.92
|
| Rate for Payer: Ohio Health Group HMO |
$156.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$167.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$181.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$144.21
|
| Rate for Payer: PHCS Commercial |
$200.64
|
| Rate for Payer: United Healthcare All Payer |
$183.92
|
|
|
NAIL DEBRIDEMENT 6 OR MORE(T
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
HCPCS 11721
|
| Hospital Charge Code |
761T0095
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.88 |
| Max. Negotiated Rate |
$200.64 |
| Rate for Payer: Aetna Commercial |
$160.93
|
| Rate for Payer: Anthem Medicaid |
$71.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$54.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$163.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$76.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.09
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Cigna Commercial |
$173.47
|
| Rate for Payer: First Health Commercial |
$198.55
|
| Rate for Payer: Humana Commercial |
$177.65
|
| Rate for Payer: Humana KY Medicaid |
$71.88
|
| Rate for Payer: Humana Medicare Advantage |
$54.88
|
| Rate for Payer: Kentucky WC Medicaid |
$72.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$171.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$154.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$73.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$183.92
|
| Rate for Payer: Ohio Health Group HMO |
$156.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$167.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$181.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$144.21
|
| Rate for Payer: PHCS Commercial |
$200.64
|
| Rate for Payer: United Healthcare All Payer |
$183.92
|
|
|
NAIL DUALCOMP HINDFT 12.5*240
|
Facility
|
OP
|
$77,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,100.00 |
| Max. Negotiated Rate |
$73,920.00 |
| Rate for Payer: Aetna Commercial |
$59,290.00
|
| Rate for Payer: Anthem Medicaid |
$26,480.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,060.00
|
| Rate for Payer: Cash Price |
$38,500.00
|
| Rate for Payer: Cigna Commercial |
$63,910.00
|
| Rate for Payer: First Health Commercial |
$73,150.00
|
| Rate for Payer: Humana Commercial |
$65,450.00
|
| Rate for Payer: Humana KY Medicaid |
$26,480.30
|
| Rate for Payer: Kentucky WC Medicaid |
$26,749.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63,140.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,826.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,100.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,011.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$67,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$57,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66,990.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53,130.00
|
| Rate for Payer: PHCS Commercial |
$73,920.00
|
| Rate for Payer: United Healthcare All Payer |
$67,760.00
|
|
|
NAIL DUALCOMP HINDFT 12.5*240
|
Facility
|
IP
|
$77,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,100.00 |
| Max. Negotiated Rate |
$73,920.00 |
| Rate for Payer: Aetna Commercial |
$59,290.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,060.00
|
| Rate for Payer: Cash Price |
$38,500.00
|
| Rate for Payer: Cigna Commercial |
$63,910.00
|
| Rate for Payer: First Health Commercial |
$73,150.00
|
| Rate for Payer: Humana Commercial |
$65,450.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63,140.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,826.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,100.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$67,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$57,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66,990.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53,130.00
|
| Rate for Payer: PHCS Commercial |
$73,920.00
|
| Rate for Payer: United Healthcare All Payer |
$67,760.00
|
|
|
NAIL GUIDEWIRE BEADED 2.2M*98C
|
Facility
|
IP
|
$1,561.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$468.30 |
| Max. Negotiated Rate |
$1,498.56 |
| Rate for Payer: Aetna Commercial |
$1,201.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,217.58
|
| Rate for Payer: Cash Price |
$780.50
|
| Rate for Payer: Cigna Commercial |
$1,295.63
|
| Rate for Payer: First Health Commercial |
$1,482.95
|
| Rate for Payer: Humana Commercial |
$1,326.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,280.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,152.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$468.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,373.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,170.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,248.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,358.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,077.09
|
| Rate for Payer: PHCS Commercial |
$1,498.56
|
| Rate for Payer: United Healthcare All Payer |
$1,373.68
|
|
|
NAIL GUIDEWIRE BEADED 2.2M*98C
|
Facility
|
OP
|
$1,561.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$468.30 |
| Max. Negotiated Rate |
$1,498.56 |
| Rate for Payer: Aetna Commercial |
$1,201.97
|
| Rate for Payer: Anthem Medicaid |
$536.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,217.58
|
| Rate for Payer: Cash Price |
$780.50
|
| Rate for Payer: Cigna Commercial |
$1,295.63
|
| Rate for Payer: First Health Commercial |
$1,482.95
|
| Rate for Payer: Humana Commercial |
$1,326.85
|
| Rate for Payer: Humana KY Medicaid |
$536.83
|
| Rate for Payer: Kentucky WC Medicaid |
$542.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,280.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,152.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$468.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$547.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,373.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,170.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,248.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,358.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,077.09
|
| Rate for Payer: PHCS Commercial |
$1,498.56
|
| Rate for Payer: United Healthcare All Payer |
$1,373.68
|
|
|
NAIL GUIDEWIRE BEADED 3.0M*98C
|
Facility
|
OP
|
$1,561.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$468.30 |
| Max. Negotiated Rate |
$1,498.56 |
| Rate for Payer: Aetna Commercial |
$1,201.97
|
| Rate for Payer: Anthem Medicaid |
$536.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,217.58
|
| Rate for Payer: Cash Price |
$780.50
|
| Rate for Payer: Cigna Commercial |
$1,295.63
|
| Rate for Payer: First Health Commercial |
$1,482.95
|
| Rate for Payer: Humana Commercial |
$1,326.85
|
| Rate for Payer: Humana KY Medicaid |
$536.83
|
| Rate for Payer: Kentucky WC Medicaid |
$542.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,280.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,152.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$468.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$547.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,373.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,170.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,248.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,358.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,077.09
|
| Rate for Payer: PHCS Commercial |
$1,498.56
|
| Rate for Payer: United Healthcare All Payer |
$1,373.68
|
|
|
NAIL GUIDEWIRE BEADED 3.0M*98C
|
Facility
|
IP
|
$1,561.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$468.30 |
| Max. Negotiated Rate |
$1,498.56 |
| Rate for Payer: Aetna Commercial |
$1,201.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,217.58
|
| Rate for Payer: Cash Price |
$780.50
|
| Rate for Payer: Cigna Commercial |
$1,295.63
|
| Rate for Payer: First Health Commercial |
$1,482.95
|
| Rate for Payer: Humana Commercial |
$1,326.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,280.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,152.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$468.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,373.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,170.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,248.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,358.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,077.09
|
| Rate for Payer: PHCS Commercial |
$1,498.56
|
| Rate for Payer: United Healthcare All Payer |
$1,373.68
|
|
|
NAIL LONG LEFT 11*320MM
|
Facility
|
IP
|
$11,225.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,367.61 |
| Max. Negotiated Rate |
$10,776.34 |
| Rate for Payer: Aetna Commercial |
$8,643.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,755.77
|
| Rate for Payer: Cash Price |
$5,612.68
|
| Rate for Payer: Cigna Commercial |
$9,317.04
|
| Rate for Payer: First Health Commercial |
$10,664.08
|
| Rate for Payer: Humana Commercial |
$9,541.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,204.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,284.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,367.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,878.31
|
| Rate for Payer: Ohio Health Group HMO |
$8,419.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,980.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,766.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,745.49
|
| Rate for Payer: PHCS Commercial |
$10,776.34
|
| Rate for Payer: United Healthcare All Payer |
$9,878.31
|
|
|
NAIL LONG LEFT 11*320MM
|
Facility
|
OP
|
$11,225.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,367.61 |
| Max. Negotiated Rate |
$10,776.34 |
| Rate for Payer: Aetna Commercial |
$8,643.52
|
| Rate for Payer: Anthem Medicaid |
$3,860.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,755.77
|
| Rate for Payer: Cash Price |
$5,612.68
|
| Rate for Payer: Cigna Commercial |
$9,317.04
|
| Rate for Payer: First Health Commercial |
$10,664.08
|
| Rate for Payer: Humana Commercial |
$9,541.55
|
| Rate for Payer: Humana KY Medicaid |
$3,860.40
|
| Rate for Payer: Kentucky WC Medicaid |
$3,899.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,204.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,284.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,367.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,937.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,878.31
|
| Rate for Payer: Ohio Health Group HMO |
$8,419.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,980.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,766.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,745.49
|
| Rate for Payer: PHCS Commercial |
$10,776.34
|
| Rate for Payer: United Healthcare All Payer |
$9,878.31
|
|
|
NAIL TIBIAL T2 10*330MM
|
Facility
|
OP
|
$7,814.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,344.30 |
| Max. Negotiated Rate |
$7,501.78 |
| Rate for Payer: Aetna Commercial |
$6,017.05
|
| Rate for Payer: Anthem Medicaid |
$2,687.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,095.19
|
| Rate for Payer: Cash Price |
$3,907.18
|
| Rate for Payer: Cigna Commercial |
$6,485.91
|
| Rate for Payer: First Health Commercial |
$7,423.63
|
| Rate for Payer: Humana Commercial |
$6,642.20
|
| Rate for Payer: Humana KY Medicaid |
$2,687.35
|
| Rate for Payer: Kentucky WC Medicaid |
$2,714.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,407.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,766.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,344.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,741.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,876.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,860.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,251.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,798.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,391.90
|
| Rate for Payer: PHCS Commercial |
$7,501.78
|
| Rate for Payer: United Healthcare All Payer |
$6,876.63
|
|
|
NAIL TIBIAL T2 10*330MM
|
Facility
|
IP
|
$7,814.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,344.30 |
| Max. Negotiated Rate |
$7,501.78 |
| Rate for Payer: Aetna Commercial |
$6,017.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,095.19
|
| Rate for Payer: Cash Price |
$3,907.18
|
| Rate for Payer: Cigna Commercial |
$6,485.91
|
| Rate for Payer: First Health Commercial |
$7,423.63
|
| Rate for Payer: Humana Commercial |
$6,642.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,407.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,766.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,344.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,876.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,860.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,251.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,798.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,391.90
|
| Rate for Payer: PHCS Commercial |
$7,501.78
|
| Rate for Payer: United Healthcare All Payer |
$6,876.63
|
|
|
NALOXONE 0.01mg(2MG/2ML)
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
HCPCS J2312
|
| Hospital Charge Code |
25002258
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.70 |
| Max. Negotiated Rate |
$181.44 |
| Rate for Payer: Aetna Commercial |
$145.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$147.42
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$156.87
|
| Rate for Payer: First Health Commercial |
$179.55
|
| Rate for Payer: Humana Commercial |
$160.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$154.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$139.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$166.32
|
| Rate for Payer: Ohio Health Group HMO |
$141.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$151.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$164.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$130.41
|
| Rate for Payer: PHCS Commercial |
$181.44
|
| Rate for Payer: United Healthcare All Payer |
$166.32
|
|
|
NALOXONE 0.01mg(2MG/2ML)
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
HCPCS J2312
|
| Hospital Charge Code |
25002258
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.70 |
| Max. Negotiated Rate |
$181.44 |
| Rate for Payer: Aetna Commercial |
$145.53
|
| Rate for Payer: Anthem Medicaid |
$65.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$147.42
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$156.87
|
| Rate for Payer: First Health Commercial |
$179.55
|
| Rate for Payer: Humana Commercial |
$160.65
|
| Rate for Payer: Humana KY Medicaid |
$65.00
|
| Rate for Payer: Kentucky WC Medicaid |
$65.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$154.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$139.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$66.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$166.32
|
| Rate for Payer: Ohio Health Group HMO |
$141.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$151.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$164.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$130.41
|
| Rate for Payer: PHCS Commercial |
$181.44
|
| Rate for Payer: United Healthcare All Payer |
$166.32
|
|
